Assessment of QT intervals and prevalence of short QT syndrome in Japan

BACKGROUND: Long QT syndrome causes ventricular tachyarrhythmias and sudden death. Recently, a short QT interval has also been shown to be associated with an increased risk of tachyarrhythmia and sudden death. However, the prevalence of short QT syndrome is not well-known. HYPOTHESIS: The aim of this study was to assess the distribution of corrected QT intervals (QTc) and prevalence of short QT syndrome. METHODS: This study comprised 12,149 consecutive subjects who received a consultation at Kanazawa University Hospital, Kanazawa, Japan, and had an electrocardiogram (ECG) between February 2003 and May 2004. Of these subjects, 1,165 subjects were excluded because of inappropriate ECGs, while the remaining 10,984 subjects had their last-recorded ECGs analyzed. RESULTS: The QTc values showed a nearly normal distribution (408 +/- 25 msec(1/2)), and were significantly longer in females (412 +/- 24 msec(1/2)) than in males (404 +/- 25 msec(1/2)) (p < 0.05). Among 5,511 males, 69 subjects (1.25%) exhibited QTc < 354 msec(1/2) (2 standard deviations [SDs] below the mean in males), and among 5,473 females, 89 subjects (1.63%) exhibited QTc < 364 msec(1/2) (2 SDs below the mean in females). Only 3 subjects (0.03% in all subjects and 0.05% in males) exhibited QTc < 300 msec(1/2), however, none had clinical symptoms of short QT syndrome. CONCLUSIONS: Short QT syndrome may be very rare.     

Histological changes of superficial esophageal squamous cell carcinoma after preoperative chemotherapy

Introduction

We aimed to analyze the clinical and histological effects of chemotherapy in superficial esophageal squamous cell carcinoma (SESCC).

Methods

We analyzed tumor samples from five patients with cT1bN1M0 who underwent subtotal esophagectomy following two courses of a new triplet chemotherapy regimen including docetaxel, cisplatin, and 5-fluorouracil (DCF). To assess the histological effects of chemotherapy, resected specimens were analyzed by macroscopic examination, hematoxylin & eosin (HE) staining, immunohistochemical (IHC) staining (p53, Ki-67 and cytokeratin) and periodic acid-Schiff (PAS) staining.

Results

All five patients had a pathological T stage of T0/1a-LPM/1a-MM/1b (1/2/1/1) and histological grade of grade1a/1b/2/3 (1/1/2/1). Endoscopic examination revealed substantial shrinkage of lugol-voiding lesions (LVLs) in all cases. One case showed complete LVL disappearance, and resected specimen examination confirmed pathological complete response (pCR). IHC and PAS staining revealed that most initial LVLs were PAS-negative. Obvious viable cells were confirmed in two cases. The other three cases exhibited nuclear atypia and strong expression of p53 and Ki-67 in the basal layer of mucosa or lamina propria mucosae, even though the superficial layer of mucosa showed no obvious LVLs with PAS-positive. p53-positive lesions were also observed in Ki-67-positive. This indicated discordance between the endoscopic findings and histopathological evaluation.

Conclusion

DCF chemotherapy alone had a substantial therapeutic effect on SESCC in all cases. However, despite the normal appearance of the mucosal surface, viable cancer cells remained below the basal layer of mucosa. Careful attention should be paid when diagnosing clinical CR, or securing a resection margin of SESCC after DCF chemotherapy.

     

A case of Langerhans cell histiocytosis which resolved only on smoking cessation]

We report a case with Langerhans cell histiocytosis appearing as an extra-pleural tumor. A 20-year-old man was transferred to our hospital because of right chest pain and fever. His chest X-ray showed an extra-pleural mass and chest CT scan showed a mass lesion with right 7th rib fracture. 67Gallium and bone scintigram showed uptake at the same site. We performed a CT-guided puncture biopsy. Pathological findings of the specimen showed diffuse proliferation of histiocytoid cells with some eosinophils. The histiocytes were positive for S-100 protein and CD1a on immunohistochemical stain. Langerhans cell histiocytosis was diagnosed. There was no other involvement of the disease except the rib. The tumor resolved only with smoking cessation and no recurrence was observed during the follow-up period. An association between smoking and progressions of the rib disease was suggested.     

Central retinal artery color Doppler monitoring versus transcranial Doppler monitoring in cardiac surgery

We hypothesized that the central retinal artery color Doppler (CRAD) technique can be used as an alternative monitoring method to the conventional transcranial Doppler (TCD) technique which does not consistently provide good signals during cardiopulmonary bypass. This is the first study to compare CRAD with TCD during cardiac surgery. Twenty patients without stroke were examined at the seven preset stages of the two procedures. The maximum flow velocity (V _max) of the right central retinal artery was measured with a 7.5-MHz Doppler system. The V _max of the right middle cerebral artery was measured with a TCD system. To estimate the relationship between V _max and maximum blood pressure (BP_max), CRAD-V _max (6.6 ± 2.2 cm/s), TCD-V _max (44.0 ± 14.8 cm/s), and BP_max (114 ± 28.5 mmHg) obtained at the initial stage were normalized. The V _max values of CRAD were successfully obtained, at each of the seven study stages, in all 20 patients. The V _max values of TCD were obtained at 125 points, and 15 missing values were seen during the stages of cardiopulmonary bypass. CRAD-V _max was correlated to TCD-V _max (r = 0.775, P < 0.0001). The normalized values of both TCD- and CRAD-V _max were correlated to the normalized BP_max (r = 0.766, P < 0.0001) (r = 0.787, P < 0.0001). The accuracy of CRAD was confirmed by the significant correlation with TCD. Received: November 25, 1999 / Accepted: March 18, 2000     

Self-reported depressive state can be a predictor of engagement in work by community-dwelling elderly 2 years later

Background:   Depression is one of the most common medical disorders in elderly community-dwelling persons. The present study prospectively examined the relationship between depressive state in elderly persons and their engagement in work and/or activities during the subsequent 2 years.
Methods:   The study subjects were 603 persons who were engaged in work/activities at baseline. Their mean age ± standard deviation was 71 ± 5.1 years and 299 (49.6%) were men. The final outcome regarding engagement in work was based on whether they held a job or were engaged in activities, such as farming or gardening, every day.
Results:   At baseline, the mean SDS score was 35.5 ± 8.8 (20–63). The number of people engaged in work after 2 years decreased with increasing intensity of depressive state. Those who were engaged in work after 2 years were younger ( P  = 0.001), male ( P  = 0.047), married ( P  = 0.001), and with better financial conditions ( P  = 0.048). They were also independently able to fulfil BADL ( P  = 0.006), did not have a history of stroke ( P  = 0.040), were not regularly taking medication ( P  = 0.001) and were not depressed ( P  = 0.001). After adjustment for these covariates, depressive state was a significant independent explanatory variable, and a moderate to severe depressive state (i.e. SDS score of 48 or more) was significantly associated with less engagement in work compared with an SDS score of 39 or less (odds ratio, 2.35; 95%CI, 1.40–4.59).
Conclusion:   Depressive state is associated with an increased risk of decline in engagement in work.     

Octreotide prevents L-asparaginase-induced pancreatic injury in rats

OBJECTIVE: L-asparaginase (ASNase) is one of the most effective chemotherapeutic means for inducing remission in acute lymphoblastic leukemia. However, because of unknown risk factors, severe pancreatitis sometimes occurs in patients receiving ASNase. We assessed the effect of ASNase on pancreatic acinar cells and then investigated the preventive effects of octreotide against ASNase-induced pancreatic injury in rats. MATERIALS AND METHODS: Rats received intraperitoneal injections of an Escherichia coli ASNase solution (200, 500, or 1000 IU/kg) or normal saline as a control every 24 hours for 5 days. Octreotide (3 microg/kg) was injected subcutaneously with ASNase (1000 IU/kg) every 8 hours for 5 days. Rats were sacrificed 24 hours after the last injection of ASNase or normal saline. RESULTS: Only the rats given 1000 IU/kg ASNase had significantly increased levels of pancreatic amylase (1962 +/- 152 vs 2179 +/- 84 IU/L, p < 0.01), trypsin (27.3 +/- 3.6 vs 41.1 +/- 22.8 IU/L, p < 0.05), and pancreatic secretory trypsin inhibitor (0.03 +/- 0.09 vs 0.27 +/- 0.10 ng/mL, p < 0.01) as compared to the control group. In addition, the acinar cells showed histological damage; however, octreotide injection provided protection against histological damage and the pancreatic enzymes remained within normal limits. CONCLUSIONS: Although ASNase by itself did not cause pancreatitis, it did cause increased levels of pancreatic enzymes and histological damage to the pancreas associated with pancreatic injury or pre-pancreatitis. Prior treatment with octreotide prevented the development of ASNase-induced pancreatic injury.     

Insulin enhances leukocyte-endothelial cell adhesion in the retinal microcirculation through surface expression of intercellular adhesion molecule-1

The purpose of this study was to evaluate the effects of insulin on leukocyte-endothelial cell adhesion in the retinal microcirculation in vitro and in vivo. Human retinal endothelial cells (HRECs) were cultured in medium with or without insulin, and neutrophils allowed to adhere. Adherent neutrophils were quantified by measuring myeloperoxidase activity. Surface expression of endothelial adhesion molecules were studied with the use of an enzyme immunoassay. Insulin at concentrations of 50 and 100 microU/ml significantly increased neutrophil adhesion to HRECs compared with the control cells (P < 0.01, respectively). Surface expression of intercellular adhesion molecule-1 (ICAM-1) significantly increased when HRECs were exposed to 100 microU/ml insulin, as compared with the control cells (P < 0.05). Anti-ICAM-1 antibody significantly inhibited neutrophils adhesion to HRECs (P < 0.0001). Brown-Norway rats received subcutaneous injection of 0.2 U per 100 g body weight insulin three times. Control rats received the same amount of phosphate-buffered saline. Leukocyte entrapment in the retina was evaluated using acridine orange leukocyte fluorography. The number of leukocytes trapped in the retina of insulin-treated rats was significantly elevated compared with that in the control animals (P < 0.0001). These results suggested that insulin enhances leukostasis in retinal microcirculation. Hyperinsulinemia may be a risk factor of retinal microcirculatory disturbances.     

Sex Differences in Left Ventricular Cavity Dilation and Outcomes in Acute Heart Failure Patients With Left Ventricular Systolic Dysfunction

Background

In this study we evaluated the influence of sex on the left ventricular end-diastolic dimension (LVEDD) and adverse outcomes in patients hospitalized for acute decompensated heart failure (HF) with a reduced ejection fraction (EF).

Pleural involvement in the course of chronic myelomonocytic leukemia and the development of multiple colonic perforation due to leukemic infiltration in the acute leukemia phase

A 68-year-old man with chronic myelomonocytic leukemia (CMML) was initially treated with hydroxyurea with subsequent stable disease. In the time course, he developed bilateral pleuritis accompanied by leukocytosis and spiking fever. Cytologic analysis of the pleural effusion revealed abundant mature granulocytes and monocytes. He was treated with intravenous or oral etoposide with consequent resolution of the pleuritis, indicating the pleural involvement of CMML. Three months later, he developed hepatomegaly and became febrile. One month thereafter, the CMML transformed to acute myeloid leukemia, and the patient developed massive bloody stools associated with epigastric pain and leukocytosis. A gastrofiberscopic examination showed multiple bleeding gastric ulcers. The bleeding ulcers were treated with the clipping procedure; however, the bloody stools continued. Although intravenous etoposide was effective for the leukocytosis and hepatomegaly, the treatment did not improve the bloody stools. The patient finally died of panperitonitis. The autopsy showed multiple ulcers of the transverse colon, some of which were perforated. Microscopically, the ulcerated areas were densely infiltrated with leukemic cells predominantly consisting of immature monocytes and granulocytes. This patient may be the first reported case of CMML complicated by colonic perforation due to leukemic infiltration.     

Dietary Patterns and Serum Gamma-Glutamyl Transferase in Japanese Men and Women

Background

Although specific foods and nutrients have been examined as potential determinants of serum gamma-glutamyl transferase (GGT) concentrations, the relationship between dietary patterns and GGT remains unknown. The present cross-sectional study aimed to determine relationships between dietary patterns and GGT concentrations, and the effects of lifestyle factors on GGT.

Methods

Relationships between dietary patterns and GGT were analyzed in 9803 Japanese individuals (3723 men and 6080 women age 40–69 years) without a history of liver diseases or elevated serum aminotransferase. We examined major dietary patterns by factor analysis of 46 items determined from a validated, short food frequency questionnaire.

Results

We defined dietary patterns as healthy, Western, seafood, bread, and dessert. The healthy pattern was inversely related to GGT in men (odds ratio [OR] for highest vs lowest quartile, 0.72; 95% confidence interval [CI], 0.57–0.92; P < 0.01 for trend) and women (OR 0.82; 95% CI, 0.66–1.0; P = 0.05 for trend), whereas the seafood pattern was positively related to GGT in men (OR 1.27; 95% CI, 1.01–1.61; P = 0.03 for trend) and women (OR 1.21; 95% CI, 0.98–1.49; P = 0.05 for trend). Male-specific inverse associations with GGT were found for bread and dessert patterns (OR 0.63; 95% CI, 0.50–0.80 and OR 0.53; 95% CI, 0.41–0.68, respectively; P < 0.01 for both trends). Seafood or bread patterns and alcohol consumption significantly interacted with GGT in men (P = 0.03 and <0.01 for interaction, respectively) and between the dessert pattern and body mass index or smoking habit in women (P = 0.03 and <0.01, respectively, for interaction).

Conclusions

Dietary patterns may be important determinants of GGT, and their possible clinical implications warrant further investigation.Key words: dietary pattern, gamma-glutamyl transferase, factor analysis